Differential Diagnosis for a 75-year-old man with B/L leg swelling, Dizziness, and Episodic SOB
- Single most likely diagnosis
- Heart Failure (HF): The patient's symptoms of bilateral leg swelling, dizziness, and episodic shortness of breath (SOB), along with significantly elevated BNP (3700), strongly suggest heart failure as the primary cause of his symptoms. The presence of hepatomegaly and hyperbilirubinemia further supports this diagnosis, as they can be associated with right-sided heart failure leading to liver congestion.
- Other Likely diagnoses
- Chronic Obstructive Pulmonary Disease (COPD) exacerbation: Although the chest is clear on auscultation, COPD could still be a contributing factor to SOB, especially if the patient has a history of COPD. However, the absence of wheezing or other respiratory findings makes this less likely.
- Anemia: Could contribute to SOB and dizziness, but would not directly explain the leg swelling or hepatomegaly.
- Renal Failure: Could lead to fluid overload causing leg swelling and SOB, but the primary symptoms and signs point more directly to heart failure.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pulmonary Embolism (PE): Although the chest is clear and there's no mention of chest pain or other typical PE symptoms, it's crucial to consider PE due to its high mortality rate if missed. The dizziness and SOB could be indicative of a large PE.
- Cardiac Tamponade: Could cause SOB, dizziness, and potentially hepatomegaly due to impaired cardiac filling, but would typically present with more pronounced hypotension and specific echocardiographic findings.
- Rare diagnoses
- Constrictive Pericarditis: Could explain the hepatomegaly and SOB due to impaired diastolic filling, but is less common and would typically have distinctive echocardiographic or CT findings.
- Restrictive Cardiomyopathy: Similar to constrictive pericarditis, it could cause SOB and hepatomegaly due to impaired ventricular filling, but is less common than heart failure and would require specific diagnostic testing for differentiation.